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4 <br /> r e .. _FQR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit <br /> -------------------------------- ------ --_-------- <br /> - <br /> ............................ <br /> ......... ­.---- -.- - .- This Permit Expires 1 Year From Date Issued Date Issued.-.2.1_7Z4. <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549.0nd existing Rules and Regulations: <br /> I / ; e <br /> JOB ADDRESS/LOCATION.." -- d dQ7� <br /> - --------- '--I1/Ii' .�".._Ifs 1�----•- ------------------CENSUS TRACT.-----•-••--------........ <br /> Owner's Name. -- Ph on,.. LCA . -? <br /> Address.. i7f .. ... y .G . ZiPiCit .... �/ <br /> -- ----- <br /> Contracto' r's Name-.-........... <br /> .. . ............ ....License # 5`5-: ..Phone....-- • ----- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> i /Motel ❑ Other-- --------- - ---------- --------- <br /> Number <br /> --Number of living units:.../----------Number of bedrooms.`Garbage Grinder------------Lot Size... �1 " <br /> ................... <br /> Water Supply: Public System and name....---._- -------------- ----- Private <br /> ------- <br /> Character of soil to a depth of 3 feet. Sand ❑ Silt❑Clay ❑ Peat M Sandy LoomX[ Clay Loam ❑ <br /> 4 '_ Hardpan ��Adobe-E�Fill�Material . .... ..-Jf yes, type......... <br /> ) <br /> (Plot plan, showing size of lot, iocatio� of system in relation to wells, buildings, etc, must be placed on reverse side.] <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,[ ! <br /> I <br /> PACKAGE TREATMENT [ ) SEPTIC TANK [ ] Size.. - _ ,�"�iW, <br /> Liquid Depth------- ---- -.--- <br /> t CapacityrZ1 TYPe/��Wi4 ..Material_.....- ----------No. Compartments ------a ------------ c <br /> Distance to nearest; Well--- ------."-------------Foundation..�O .. - Pro Line_. .4� <br /> iP. /............. ........� <br /> LEACHING LINE [ ] No, of Lines ., Len th of each line.- .. F— Al. <br /> 5 ...- Total Length . <br /> ------------------- <br /> : .. <br /> D' Box---(......Type Filter Material.VP.}e: epth Filter Material....... <br /> ...... ..... .......� <br /> . <br /> Di-stance-to nearestWell-e _ ��-_- � ..".Foundation-. <br />� - �, , - -�-- . rl�_--------- •--::�...Rroperty_Line.�C=�P?.___.__:r���_:-.:::-.�-7 <br /> SEEPAGE;PIT [ ] Depth._ ... ....Diameter------------ ...Number-:------------ ----------- Rock Filled Yes ❑ No ❑G' <br /> ' f <br /> Water Table Depth------ -------- ........... . ------...._...Rock Size.'............ ........... <br /> Distance to nearest: Well_-------------------.........------------Foundation..........................Prop. Line..........-..--.... .-..-.--.� <br /> REPAIR/ADDITION (Prev. Sanitation Permit#........".......................... .........."....Date--.......... ...--.--...--..........-._-- --- ) <br /> Septic Tank [specify Requirements] _ = -` ------------- i - -- - ------------------ <br /> Disposal Field (Specify Requirements}' `----------------- ------------------------- .....-4 <br /> --- ----.... <br /> ..-...--- . ...........�-- ..............' ,'� . : <br /> . ...................... ".." ---------..-.--.-------.- ................................................ <br /> -4e; Y, (Draw exiting and required addition on reverse side) <br /> I hereby ceftify that I have prvparrtl ed„this application and that the work will be done i~ accordance nce with San Joaquin County <br /> Ordinances, State Laws, and `Rules'and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following:., �,%a ,F <br /> "I certify that,in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become sbje �orkmnpensation laws of California." <br /> Signed Owner <br /> t � <br /> By_ --- ------... .... --- `-• 2- ---- -- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.."� »�... .W. ...-.". '"� �---K DATE _5:. ycl........ <br /> DIVISION OF LAND NUMBER---------- --- -- '' ........................ -_....... ...... -------- -----------.DATE.-..........................-- ------ <br /> ADDITIONAL COMMENTS_--....................... .,.. <br />. ..................... --------- - ------ - - ------------------ - - ----- ..... ....................... ............ <br /> -- <br /> u <br /> --------------------- ------------------4........ ....... --------I...................... ------- ---------- .......... <br /> Final Inspection by - p - Date -��.... <br /> EH 19 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 2,bn 7/76 31 <br />